Individual Name *

First Name

Last Name

Parent/Guardian (if Individual is younger than 18 years)

First Name

Last Name

Phone *

(###)

###

####

1) I understand the novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization and that COVID-19 is extremely contagious. *

Yes

No

2) I am attending and participating voluntarily in this activity, program, event or service. I understand my participation (or my child’s participation, if the participant is a minor) in this activity, program, event or service may involve the risk of serious injury and/or death including the risks associated with COVID-19. I agree to assume those risks, including but not limited to exposure to COVID-19. *

Yes

No

3) I acknowledge there are hazards and risks of physical injury or illness to myself (or my child, if the participant is a minor) in attending the premises and participating in this activity, program, event or service. I agree to assume those risks, including the risk of death, bodily injury or illness (including illness from COVID-19), that I (or my child) may sustain as a result of my (or my child’s) participation in this activity, program, event or service, however arising, including, but not limited to, the negligence of the Releasees. *

Yes

No

4) I agree to indemnify and release the Releasees from any and all causes of actions, claims (including Third Party claims), demands, or loss in respect of any personal injuries, damages or death which may occur or arise during my (or my child’s) participation in this activity, program, event or service or while attending the premises. *

Yes

No

5) I hereby acknowledge and agree I will not commence litigation or otherwise seek to recover damages or other compensation against the Releasees based on any action, claim, demand, or loss arising from my (or my child’s) participation in this activity, program, event or service or while attending the premises, including any potential or actual exposure to COVID-19. *

Yes

No

6) I further acknowledge the Releasees can rely on this Waiver as a complete defence to any and all claims, damages, causes of action, or liability that may arise in connection with my (or my child’s) participation in this activity, program, event or service or while attending the premises. *

Yes

No

7) I understand and agree this Waiver is intended to be as broad and inclusive as permitted by the laws of the Province of Alberta, and that the invalidity or unenforceability of any term of this Waiver does not affect the validity or enforceability of any other term. Any invalid term will be treated as severed from the remaining terms. *

Yes

No

8) I have carefully reviewed this Waiver and I fully understand and accept the terms set out above. I further understand I have given up substantial legal rights by signing this Waiver and I have done so voluntarily. By clicking "Submit," I am agreeing to be bound by the terms of this legal document. *

Yes

No

Date

MM

DD

YYYY